Vulvar Varicose Veins: How to Recognise Them and Provide Effective Relief?

Vulvar varicose veins are caused by an abnormal dilation of the veins in the vulva, i.e., the external part of the female genitalia. They usually manifest as visible or palpable swelling of the veins, accompanied by a feeling of heaviness, localised tension, or even pain in the genital area.

Varicose Veins and Pelvic Veins

These varicose veins are supplied by the pelvic veins and result from a dysfunction of venous return: when the venous valves no longer function properly, blood is unable to flow back effectively to the heart and tends to pool in the superficial veins. This pooling causes local congestion and leads to the gradual distension of the vein walls.

Varicose Veins and Pregnancy

In most cases, vulvar varicose veins appear during pregnancy, due to the combined effect of hormonal changes (particularly increased progesterone) and the pressure exerted by the uterus on the pelvic veins. However, they can also occur outside of pregnancy, particularly in connection with chronic venous insufficiency, pelvic congestion syndrome or a family predisposition.

In some cases, they coexist with other varicose veins in the pelvis (vaginal, perineal or even gluteal) and may extend up the thighs. It is important to emphasise that these varicose veins are not merely a cosmetic concern: they can cause persistent pain, functional discomfort in daily life and a significant psychological impact. Although they are generally benign, medical advice remains essential to assess their severity and recommend appropriate management.

Vulvar varicose veins can have several causes. These causes are often interlinked, and several factors may be present simultaneously in the same woman.

Pregnancy

Pregnancy is the main cause of vulvar varicose veins. During this period, the body undergoes numerous changes that contribute to their development. Under the influence of oestrogen, the vein walls lose their tone, dilate more easily, and become more sensitive to pressure. At the same time, blood volume increases to ensure the necessary supply to the foetus, placing greater strain on the pelvic venous system. As the uterus grows in size, it also exerts direct pressure on the veins in the pelvis, which can impede the return of blood to the heart and exacerbate blood pooling in the vulvar veins. These changes are particularly pronounced during the second and third trimesters.

Pelvic Congestion Syndrome

This condition, which is sometimes poorly understood, is characterised by poor venous circulation in the pelvis. It is often caused by abnormal dilation of the ovarian, uterine or perineal veins. This venous congestion can extend as far as the vulvar veins. It often causes chronic pelvic pain, particularly towards the end of the day or after standing for long periods. This syndrome is exacerbated by a family history of varicose veins, multiple pregnancies, or persistent hormonal imbalances.

Genetic Predisposition

Heredity plays an important role in the development of vulvar varicose veins. If there is a family history of varicose veins, whether in the pelvis or the lower limbs, the risk of developing them yourself is higher. This predisposition may be due to a congenital weakness of the venous tissue.

Prolonged Standing

Jobs that require standing for long periods, such as shop assistants, hairdressers, nurses, etc., increase pressure in the veins of the lower body. This slows down venous return and increases the likelihood of varicose veins developing in the pelvis, perineum, or vulva. Conversely, a lifestyle that is too sedentary can also impair circulation.

Weight Gain

Being overweight puts extra pressure on the pelvic veins. This mechanical strain can interfere with the proper functioning of the venous valves, leading to blood pooling in the veins of the vulva.

Certain Sports Activities

Physical activities that significantly increase abdominal pressure, such as weightlifting or intensive strength training, can impede venous return and exacerbate circulatory problems. This can contribute to the development of varicose veins in the vulvar region.

Hormonal Changes (excluding pregnancy)

Apart from pregnancy, other hormonal imbalances can weaken the veins. Menopause, with its drop in oestrogen levels, or certain conditions such as polycystic ovary syndrome (PCOS), can make the vein walls more sensitive and promote their dilation.

Abnormalities Of The Venous System

Some women have venous malformations, whether congenital or acquired, which hinder proper blood drainage. The presence of pelvic tumours or foci of endometriosis can compress the veins. Compression syndromes, such as Cockett’s syndrome (compression of the left common iliac vein) or Nutcracker syndrome (compression of the left renal vein), increase pressure in certain pelvic veins. Finally, a history of deep vein thrombosis can lead to post-thrombotic syndrome and cause long-term disruption to venous return.

Other Aggravating Factors

Other factors can exacerbate pelvic venous disorders. Frequently wearing tight-fitting clothing around the pelvis can compress the superficial veins. Similarly, a history of pelvic surgery or local vascular trauma can impair circulation in this area.

Vulvar varicose veins can present in very different ways from one woman to another. Here are the main possible signs:

• Visible or Palpable Swelling of the Veins in the Vulva: Bluish, dilated, tortuous veins, sometimes accompanied by bulges on one or both labia

• A Feeling of Heaviness or Tightness in the Vulvar Region: Often more pronounced at the end of the day, after prolonged standing or physical exertion

• Pelvic or Vulvar Pain: Diffuse, dull pain, sometimes throbbing, which may radiate to the perineum, thighs or lower abdomen; it often intensifies as the day progresses

• Discomfort during sexual intercourse (dyspareunia): Pain may be exacerbated during or after intercourse, and may sometimes persist for several hours after

• Itching, Burning, or Tingling: Caused by venous congestion and tissue fragility

• A Sensation of Heat or Localised Discomfort: Particularly during periods of high heat or after a hot bath

• Vulvar Oedema: Diffuse swelling of the vulva, sometimes accompanied by a bluish discolouration

• Worsening of Symptoms During Menstruation: Linked to hormonal congestion in the pelvis

• Absence of Symptoms: In some cases, vulvar varicose veins cause no symptoms and are discovered incidentally during a gynaecological examination

If you experience symptoms suggestive of vulvar varicose veins, it is essential to consult a healthcare professional. A thorough gynaecological examination allows the signs to be objectively assessed and the extent of the venous involvement to be evaluated. Depending on the case, several additional tests may be recommended to refine the diagnosis:

1. A Specialised Clinical Examination: Inspection and palpation of the vulvar, perineal and pelvic regions to detect signs of visible or deep venous dilation

2. A Pelvic and Perineal Ultrasound Scan: A first-line examination used to visualise superficial varicose veins and assess venous circulation

3. A Transvaginal Doppler Ultrasound: Used to examine the deep pelvic veins in detail, particularly the ovarian and uterine veins

4. A Pelvic Phlebography: An invasive examination performed under radiological guidance, useful where pelvic congestion syndrome is suspected; it enables the dilated pelvic venous networks to be mapped

5. A Venous Doppler Ultrasound of the Lower Limbs: Often carried out as a supplementary test to investigate associated venous involvement, particularly deep or superficial venous insufficiency

6. An MRI or CT Scan of the Pelvis: Prescribed in certain complex cases, particularly where deep pelvic varicose veins, a vascular malformation or venous compression (Cockett’s syndrome, Nutcracker syndrome, etc.) are suspected

7. Regular Monitoring: Recommended for pregnant women with vulvar varicose veins or a history of venous thrombosis

A consultation with an angiologist or a gynaecologist specialising in vascular conditions is strongly recommended to confirm the diagnosis, assess the functional impact and propose appropriate management.

In cases of significant discomfort, several treatment options may be considered: veinotonic medication, local compression therapy, or, in some cases, percutaneous embolisation of dilated veins under radiological guidance. The choice of treatment is based on an individualised assessment of the risk-benefit balance and requires regular medical follow-up.

Although it is difficult to completely prevent the onset of vulvar varicose veins, particularly during pregnancy or if there is a family history, certain habits can help limit their development and relieve the associated symptoms:

1. Exercise Regularly, Without Overdoing It: Walking, swimming, yoga, or gentle gymnastics promote venous return and reduce blood pooling in the pelvis

2. Wear Loose-fitting Clothing: Clothing that is too tight, particularly around the pelvis or thighs, impedes venous circulation. It is best to opt for comfortable, non-restrictive clothing

3. Use Suitable Compression Garments: Compression stockings or briefs may be recommended, particularly during pregnancy, to support venous return and limit the dilation of the vulvar veins

4. Elevate Your Legs and Pelvis Whilst Resting: When lying down, place a cushion under your legs or pelvis to support venous return and relieve pressure in the pelvis

5. Limit Exposure to Heat: Hot baths, saunas or prolonged exposure to the sun can worsen symptoms. It may be helpful to finish your shower with a splash of cool water on your legs and lower abdomen

6. Gentle Massages: Lymphatic drainage massages, performed from the feet towards the groin, can stimulate blood circulation. They should be gentle and pain-free

7. Avoid Standing In One Place for Extended Periods Changing position, standing up regularly, stretching or walking for a few minutes every hour helps to boost circulation

8. Adopt a Diet That Promotes Good Circulation: Foods rich in fibre, antioxidants (red berries, colourful vegetables) and Vitamin C help maintain healthy blood vessels. Staying well-hydrated is also essential

9. Supporting Venous Return with Herbal Remedies: Certain plants such as horse chestnut, red vine, or butcher’s broom may be helpful in cases of pelvic circulatory disorders. Their use must be supervised by a healthcare professional

10. Relieving Pelvic Tension: Chronic stress and muscle tension in the lower abdomen can contribute to congestion. Approaches such as sophrology, deep breathing, or abdominal massage may help

11. Seek Medical Advice If You Notice Any Warning Signs: If you experience persistent discomfort, pain or the appearance of visible veins, it is important to seek professional advice without delay to prevent symptoms from worsening

Please note that this article is in no way a substitute for a medical consultation. Vulvar varicose veins, although often benign, can sometimes indicate a more complex venous condition or require specific treatment. In the event of severe pain, sudden swelling, bleeding or any unusual symptoms, it is essential to consult a specialist without delay. Self-medication or the use of natural remedies should never be used as a substitute for informed medical advice.

Don’t be afraid to discuss your symptoms with your doctor or midwife. Vulvar varicose veins are common, and there are ways to relieve your symptoms and maintain your intimate well-being.

Stéphanie Catrysse is a naturopath (certified by the FENA), a wellness massage and lymphatic drainage practitioner, and a personal development coach. She is passionate about alternative medicine and practices a holistic approach to health.